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KELLIE DISTEFANO PA-C
NPI 1386609543
Family Medicine in Hartford, MI

Active since April 19, 2006
525 S CENTER ST, HARTFORD, MI 49057(269) 621-4063(269) 621-9972 Get Directions Write a Review

NPPES record last updated: December 18, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kellie Distefano Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLIE DISTEFANO PA-C (NPI 1386609543) is an individual family medicine provider in Hartford, Michigan, licensed in Michigan (5601002464) and active in the NPI registry since April 2006.

NPPES Registry Identity

NPI1386609543
Entity TypeIndividualFemale
Primary Taxonomy207Q00000X
Provider Legal NameKELLIE DISTEFANOCredential: PA-C
Location Address525 S CENTER STHartford, MI 49057-1362
Mailing Address400 Medical Park DrWatervliet, MI 49098-9225 · (269) 463-2431
Phone(269) 621-4063
Fax(269) 621-9972
Sole ProprietorNo
Enumeration DateApril 19, 2006
Last NPPES UpdateDecember 18, 2007
✔ NPI 1386609543 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in MI · 5601002464
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Also ListedPhysician AssistantTaxonomy 363A00000X · License 5601002464 (MI)
525 S CENTER ST, Hartford, MI 49057
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Other Identifiers 7

Medicare UPINA97349MI
Other381368745126MI · Ccm Billing # For Pa-c
Other101465MI · Glhp Pin #
OtherKD002464MI · Bcbs Provider Id #
Medicare ID-Type UnspecifiedOA16028MI · Supervising Drs Id #
Other06116AMI · Bhp Provider Id #
OtherKD09184MI · Hpm Provider Id #

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LAKELAND COMMUNITY HOSPITAL WATERVLIET
Clinic/Center (Rural Health)
525 S CENTER ST
HARTFORD, MI 49057
Van Buren County (269) 621-4063
ANN MARIE TAPPER FNP-C
Nurse Practitioner
525 S CENTER ST
HARTFORD, MI 49057
Van Buren County (269) 463-3600
LAURA IRENE GONZALEZ NP
Nurse Practitioner (Family)
525 S CENTER ST
HARTFORD, MI 49057
Van Buren County (269) 463-3600
JAY SHAH M.D.
Family Medicine
525 S CENTER ST
HARTFORD, MI 49057
Van Buren County (269) 463-3600
MRS. TAMARA NICHOLE GAISHIN PA-C
Physician Assistant
525 S CENTER ST
HARTFORD, MI 49057
Van Buren County (269) 463-3600

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kellie Distefano's NPI number?

The NPI number for Kellie Distefano is 1386609543. It was assigned to this individual provider in the NPPES registry on April 19, 2006.

Where is Kellie Distefano located?

Kellie Distefano practices at 525 S Center St, Hartford, MI 49057. The listed phone number is (269) 621-4063.

What is Kellie Distefano's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

When was this NPI record last updated?

The NPPES record for Kellie Distefano was last updated on December 18, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.